Nuchal translucency audit: a novel image‐scoring method

Herman, Arie; Maymon, Ron; Dreazen, E.; Caspi, E; Bukovsky, Ian; Weinraub, Z.

doi:10.1046/j.1469-0705.1998.12060398.x

Cited by 125 publications

(123 citation statements)

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“…In their study Herman et al [7] demonstrated the feasibility and reproducibility of the image-scoring method, mentioning that it may be employed by every center in an independent manner with minimal resources. In this report, we have shown that the scoring method is more objective than general evaluation in the assessment of image quality.…”

Section: Discussionmentioning

confidence: 99%

“…The images were first evaluated in a general manner, so that each image was either 'accepted' to be sent to the FMF or 'rejected'. Then, the images were reviewed by the same reviewers using the scoring method described previously [7]. In brief, the scoring method includes three major criteria (section, caliper placing, and skin line) which provide a score of 2 or 0 and three minor criteria (magnification, amniotic membrane, and head position) which provide a score of 1 or 0.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, Herman et al [7] have suggested an imagescoring method aimed at systematic evaluation of the quality of nuchal translucency images. The method is based on the scoring of different criteria which constitute the requirements for proper images.…”

Section: Introductionmentioning

confidence: 99%

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Utilization of the Nuchal Translucency Image-Scoring Method during Training of New Examiners

Herman

Maymon²,

Dreazen³

et al. 1999

Fetal Diagn Ther

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Training of new examiners, utilizing 1st-trimester nuchal translucency ultrasound screening, is mandatory for obtaining reproducible measurements. This study examined the contribution of the nuchal translucency image-scoring method to the process of training and its utilization as an objective tool of image evaluation and a tool for approving qualification. The study included an evaluation of the performance of two new examiners (examiners A and B) before and after intervention, using the image-scoring method. The preintervention period included 75 images evaluated by two reviewers using general evaluation and the scoring method. The report of the scoring method was submitted to the examiners and was applied to 55 images performed afterwards. The agreement between two reviewers in classifying the first 75 images as ‘accepted’ or ‘rejected’ was tested using general evaluation versus the scoring method. The effect of the intervention was examined by comparing the quality of the images between the two time periods. A chart indicating final scores of 80 successive images analyzed by examiner A was used to set criteria for assessing qualification. Using general evaluation, the reviewers disagreed on 19 (25%) of the images, whereas using the scoring method they disagreed on only 5 (7%, p < 0.01). Comparison before and after application of the intervention demonstrated significant improvement expressed by the increased rate of better quality groups (p < 0.001) and improved mean scores from 4.31 ± 0.31 to 6.15 ± 0.32 (p < 0.001). Enhanced improvement of examiner’s A performance could be attributed to the intervention rather than to his learning curve. Improvement was demonstrated in all the criteria examined; however, it was significant only for images size (from 33 to 98%), amnion demonstration (from 13 to 42%), and caliper placement (from 49 to 71%). Examiner’s A chart enabled us to set standards for assessing competence, based on the scoring method. These included a minimum of 40 scans, followed by more than ten sequential images of acceptable quality. The scoring method contributed to the process of training, as it made possible to objectively evaluate the images, pointed out specific erros, served as an efficient tool of intervention, and might be used for ascertaining competence. We recommend to consider its utilization in centers running 1st-trimester ultrasound screening during training new examiners.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Utilization of the Nuchal Translucency Image-Scoring Method during Training of New Examiners

Herman

Maymon²,

Dreazen³

et al. 1999

Fetal Diagn Ther

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“…Training in NT measurement was pioneered by the Fetal Medicine Foundation and data are monitored to ensure ongoing quality control [3,10,11]. Several image-scoring methods have been developed, including the Herman score [12] as well as that of the French College of Fetal Ultrasound [13]. However, when an NT image is subsequently considered inadequate by the clinician in charge of the patient, DS maternal serum screening incorporating this parameter cannot be considered reliable.…”

Section: Introductionmentioning

confidence: 99%

Impact of Including or Removing Nuchal Translucency Measurement on the Detection and False-Positive Rates of First-Trimester Down Syndrome Screening

Spaggiari

Czerkiewicz²,

Sault³

et al. 2015

Fetal Diagn Ther

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Introduction: First-trimester Down syndrome (DS) screening combining maternal age, serum markers (pregnancy-associated plasma protein-A and beta-human chorionic gonadotropin) and nuchal translucency (NT) gives an 85% detection rate for a 5% false-positive rate. These results largely depend on quality assessment of biochemical markers and of NT. In routine practice, despite an ultrasound quality control organization, NT images can be considered inadequate. The aim of the study was to evaluate the consequences for risk calculation when NT measurement is not taken into account. Material and Method: Comparison of detection and false-positive rates of first-trimester DS screening (PerkinElmer, Turku, Finland), with and without NT, based on a retrospective study of 117,126 patients including 274 trisomy 21-affected fetuses. NT was measured by more than 3,000 certified sonographers. Results: There was no significant difference in detection rates between the two strategies including or excluding NT measurement (86.7 vs. 81.8%). However, there was a significant difference in the false-positive rates (2.23 vs. 9.97%, p < 0.001). Discussion: Sonographers should be aware that removing NT from combined first-trimester screening would result in a 5-fold increase in false-positive rate to maintain the expected detection rates. This should be an incentive for maintaining quality in NT measurement.

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“…Well researched and validated scoring systems to assess ultrasound image quality do exist. [4][5][6][7] However, these tend to assess ultrasound images obtained for screening (rather than diagnostic) purposes. There are fundamental differences between ultrasound in screening programmes (e.g.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic image quality in gynaecological ultrasound: Who should measure it, what should we measure and how?

Cantin

Knapp

2013

Ultrasound

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Assessment of diagnostic image quality in gynaecological ultrasound is an important aspect of imaging department quality assurance. This may be addressed through audit, but who should undertake the audit, what should be measured and how, remains contentious. The aim of this study was to identify whether peer audit is a suitable method of assessing the diagnostic quality of gynaecological ultrasound images. Nineteen gynaecological ultrasound studies were independently assessed by six sonographers utilising a pilot version of an audit tool. Outcome measures were levels of inter-rater agreement using different data collection methods (binary scores, Likert scale, continuous scale), effect of ultrasound study difficulty on study score and whether systematic differences were present between reviewers of different clinical grades and length of experience. Inter-rater agreement ranged from moderate to good depending on the data collection method. A continuous scale gave the highest level of inter-rater agreement with an intra-class correlation coefficient of 0.73. A strong correlation (r ¼ 0.89) between study difficulty and study score was yielded. Length of clinical experience between reviewers had no effect on the audit scores, but individuals of a higher clinical grade gave significantly lower scores than those of a lower grade (p ¼ 0.04). Peer audit is a promising tool in the assessment of ultrasound image quality. Continuous scales seem to be the best method of data collection implying a strong element of heuristically driven decision making by reviewing ultrasound practitioners.

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Nuchal translucency audit: a novel image‐scoring method

Cited by 125 publications

References 0 publications

Utilization of the Nuchal Translucency Image-Scoring Method during Training of New Examiners

Utilization of the Nuchal Translucency Image-Scoring Method during Training of New Examiners

Impact of Including or Removing Nuchal Translucency Measurement on the Detection and False-Positive Rates of First-Trimester Down Syndrome Screening

Diagnostic image quality in gynaecological ultrasound: Who should measure it, what should we measure and how?

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